Diabetic eye disease: How regular eye exams could save vision

Individuals with diabetes are likely accustomed to regular insulin injections or a strict diet. But are they as familiar with regular eye examinations? According to the results of a new survey coinciding with National Diabetes Month, the majority of diabetic patients would say no, even though diabetes is a leading cause of vision loss in the US.

According to the National Eye Institute (NEI) of the National Institutes of Health (NIH), around 25 million Americans suffer from diabetes.

The Centers for Disease Control and Prevention (CDC) states that diabetes is the leading cause of blindness among adults aged between 20 and 74.

Figures from the CDC show that between 2005 and 2008, 4.2 million diabetes patients in the US had diabetic retinopathy – the most common form of diabetic eye disease. Of these, 655,000 suffered from advanced diabetic retinopathy, which can potentially lead to severe vision loss.

However, a new survey from Diabetic Connect – the largest social networking site for diabetes sufferers and their families – reveals that 25% of people with diabetes do not have the recommended annual dilated (retina) eye exam, which experts say could significantly reduce the risk of vision loss or blindness associated with diabetes.

Diabetic eye disease explained

Diabetic eye disease is defined as a group of eye-related health issues that are particularly common among diabetes sufferers.

Lady undergoing an eye exam
The NEI says the risk of severe vision loss from diabetic retinopathy could be reduced by 95% with early detection, timely treatment and appropriate follow-up.

According to the NEI, the most common forms of diabetic eye disease are diabetic retinopathy, cataract and glaucoma.

Diabetic retinopathy is the leading cause of blindness in diabetics – caused by a change in the blood vessels situated in the retina.

Some people with this disease experience swelling and fluid leaking from the blood vessels into the macula of the eye – the part of the retina that is responsible for sharp vision. This process is known as diabetic macular edema (DME).

Other people with diabetic retinopathy will have new blood vessels form on the surface of the retina. Both of these changes can lead to partial vision loss or complete blindness.

One major problem for patients with diabetic eye disease is that there are often no symptoms until the disease reaches an advanced stage. However, it can be detected early through a dilated eye exam.

“The best way to prevent unnecessary vision loss is through annual retina eye exams,” Dr. Carl C. Awh, retina specialist at Tennessee Retina, a group of nationally recognized specialists, told Medical News Today.

“Very often diabetic eye disease lacks any symptoms – meaning people may not know that their vision has been damaged until it’s too late.”

According to the NEI, with early detection through a dilated eye exam, timely treatment and appropriate follow-up, the risk of severe vision loss from diabetic retinopathy can be reduced by 95%.

Through early detection of diabetic retinopathy and other eye diseases, several treatment options can be offered to a patient.

These include laser eye surgery and injections of anti-vascular endothelial growth factor (anti-VEGF) medications. These block the actions of a protein that is the cause of abnormal blood vessel growth and leakage in the eye.

Below is a video from the NEI that explains the risk and treatment of diabetic eye disease:

Majority of diabetics ‘unaware of risk’ to eye health

Although people with diabetes are encouraged to have a dilated retina eye exam once every year, it seems many diabetes sufferers do not undergo these regular eye check-ups.

Diabetic Connect conducted an online survey of 1,674 patients with either type 1 or type 2 diabetes. The survey revealed that 1 in 4 people do not receive their annual eye exam, and the reasons for this are largely down to lack of awareness.

In detail, only 36% of people with diabetes said they had spoken with their doctor regarding their risk of vision loss when they were diagnosed, and 22% had never spoken to their doctor about this topic.

Of those who have never had a retina eye exam, 13% said it was because they believed they had not had diabetes long enough for it to affect their vision.

Over 50% of respondents were unaware that diabetic macular edema was a leading cause of vision loss or blindness for diabetes sufferers, and 32% did not know they needed a dilated eye exam.

Needless to say, the results of this survey are worrying, especially considering the millions of diabetes sufferers who are at risk of eye disease.

Dr. Awh said there is no doubt that there needs to be more awareness among diabetic patients regarding potential vision loss and the need for regular testing.

“In part it comes from the primary care doctors and nurses. Broader public awareness and education is also needed,” he added.

One diabetes sufferer told Medical News Today that if it was not for her awareness of the risk of diabetic eye disease, the quick actions of her endocrinologist and regular eye tests, she may have lost all vision.

‘If it wasn’t for regular eye exams, I would have gone blind’

Suzanne Gardner was diagnosed with type 1 diabetes at the age of 7.

In 1999, Suzanne began experiencing problems with her vision, such as seeing blurred colors and the inability to see details. She said she was previously made aware of the risk of vision loss due to her diabetes.

“In fact, vision loss was something that was of great concern to people who had diabetes,” she added.

“However, 41 years ago, the technology for diabetes was not as advanced as it is today. We had no means of testing blood glucose at home. So diabetes couldn’t be as well controlled as it is today with home glucose monitoring machines and insulin pumps.”

Suzanne visited an ophthalmologist who diagnosed her with diabetic retinopathy. Within 2 years of diagnosis, Suzanne was deemed legally blind.

“Despite a series of operations, my doctors could only save partial vision in one of my eyes,” she said.

However, despite this devastating outcome, Suzanne says that if it was not for regular eye examinations, she may have lost all vision:

“As soon as my endocrinologist saw signs of diabetic eye disease, we all took it very seriously.

She sent me to see a specialist who deals specifically with the retina. If it had not been for the constant visits and immediate attention of my retina specialist, I would have gone completely blind.”

‘It’s important for people to know about vision loss risk’

In spite of her vision loss, Suzanne has made a successful career for herself in the form of art.

“I was devastated by my vision loss. I couldn’t work and couldn’t drive. All of a sudden, everything about how I defined myself had changed,” she told Medical News Today.

“When a friend suggested I start painting, it was the last thing on my mind. But when I picked up the brush, it helped me through a very dark time in my life after my diagnosis, and I decided that I wanted to begin creating artwork for a living.”

Soon after the discovery of her love of art, she became a professional artist and was selling her artwork online and at shows.

“My limited eyesight gave me a new appreciation for vivid colors and focused my work on what I could accomplish, despite vision loss,” she said.

“I have learned to rely on my memory and use strong magnifying glasses since it is difficult for me to see details. I also use bright contrasting colors, which are easier for me to distinguish.”

Not only is Suzanne’s success as an artist a personal achievement, but she also hopes her work inspires other diabetes sufferers to look after their vision.

“It’s important for people to know about the risk of vision loss from diabetes. It’s my mission to use art as a way to remind people that their sight is worth protecting.

Because of my experience, it’s important to me that my paintings make a statement. I hope people see my art, hear my story and are inspired to prioritize their vision.”

Reducing the risk of diabetic eye disease

There is no doubt that by having annual retina eye exams, the risk of vision loss as a result of diabetes could be significantly reduced. But what does a dilated examination involve?

During the test, eye drops are put into a patient’s eye. These drops cause the pupils to open, allowing the doctor to clearly assess all structures of the eye, including the retina, to determine whether there is any damage or early signs of disease.

“Ophthalmologists, optometrists and retina specialists are able to conduct these exams and can direct patients to the appropriate specialists if there are findings,” explained Dr. Awh.

As well as regular dilated eye exams, the NEI says that diabetes sufferers can also reduce their risk of diabetic eye disease though good control of blood sugar, blood pressure and cholesterol levels.

To find information about how diabetes can cause vision loss, the retina eye exam and to find a retina specialist in your area, you can visit Diabetes Eye Check, a part of the American Society of Retina Specialists (ASRS).

Written by Honor Whiteman

When diabetes impacts the eye

Diabetes is one of the leading causes of blindness. Read on to know how the eye gets involved.

“Laughter is the best medicine, unless you’re diabetic; then insulin comes pretty high on the list.” Jasper Carott

Diabetes mellitus is a growing problem in India. With an estimated 50.8 million people living with diabetes, India has the largest diabetic population. In a diabetic, the high glucose levels in the blood can cause harm to most organs like the heart, arteries and veins, the eyes, kidneys, brain and nerves.

Diabetes mellitus is one of the leading causes of blindness. Diabetic eye disease primarily encompasses diabetic retinopathy and cataract, which lead to either reversible or irreversible loss of vision.

The longer the duration of diabetes, the greater is the risk of developing diabetic eye disease.

Progression is rapid in patients with uncontrolled blood sugar. Similarly high blood pressure, increased blood lipid, renal disease, pregnancy, anaemia and smoking also have an adverse effect in the progression of diabetic retinopathy.

Diabetic retinopathy

The retina is the back portion of the eye. The retina along with optic nerve connects the eye to the brain. The high blood sugar damages the cells lining the walls of the arteries and the veins of the retina. These small blood vessels may balloon in some places to form micro-aneurysms that leak fluid, blood and fat into surrounding tissues. The fluid accumulation leads to thickening of retina. When it affects the central part of the retina known as the macula, there will be a drop in vision. The function of blood is to supply oxygen to the tissues. Since the blood vessels of the retina are damaged, the oxygen supply to the retina is deprived. New blood vessels start growing in an effort to supply nutrients and oxygen to the tissues. These new vessels grow on the surface of the retina and into the vitreous, a jelly-like fluid inside the eye. Unfortunately these new vessels are extremely fragile and leaky, leading to bleeding inside the eye or vitreous haemorrhage. Scar tissue also accompanies the growth of new vessels. In advanced stages this scar tissue can contract pulling the retina along, leading to detachment.

Cataract

The lens helps in focusing light rays to get clear vision. When this lens gets opacified, it results in a cataract. In addition diabetic patients develop earlier cataracts and may require surgery to replace it with a new intra ocular lens. Sometimes, in uncontrolled diabetes, high blood sugar causes swelling of the lens. This results in temporary blurring of vision. Once the blood sugar is brought under control and remains stable for one week, vision will improve.

Treatment options

Timely treatment helps prevent further vision loss. Laser remains the mainstay of treatment for diabetic retinopathy.

For fluid accumulation in macula, laser photocoagulation in focal or grid pattern can be applied. For new vessel formation (proliferative diabetic retinopathy), panretinal laser photocoagulation reduces the oxygen demand for retina.

Hence the impulse to form new vessels is knocked off. Laser treatment is often done to prevent complications related to diabetic retinopathy but not to improve vision.

Steroids and anti-vascular endothelial growth factor (anti-VEGF) drugs are being injected directly into the eye these days in patients with certain types of macular thickening. This blocks vascular endothelial growth factor, which plays a role in the growth of new vessels.

These injections help reduce blood vessel leakage and formation of abnormal new vessels. If needed these injections are repeated at intervals of 4-6 weeks.

For advanced diabetic eye disease, surgical intervention is considered. Sutureless vitrectomy is the latest procedure in which blood and scar tissue inside the eye is removed. Laser treatment is often combined with surgery in such patients. Cataract needs surgical removal.

Hence diabetic eye problems are treatable if diagnosed early. Diabetic patients should undergo yearly examinations even if they have good vision.

Last but not the least, lifestyle management helps reduce the risk of developing type II diabetes. It can also slow or halt progression of pre-diabetes to diabetes.

Symptoms

In early stages there will not be any blurring of vision.

If the patient develops fluid accumulation in the macula they will find a drop in vision.

Sudden deterioration in vision in advanced stage can occur due to bleeding inside the eye and retinal detachment.

Temporary change in refractive error sometimes occurs due to rapid shift in blood sugar.

Glare and blurring of vision could be noticed due to cataract.

When to consult an ophthalmologist?

Don’t wait for symptoms. If you are diabetic, undergo a detailed eye examination during diagnosis itself. A yearly follow up is mandatory.

If you have diabetic retinopathy further follow up is as per ophthalmologist’s advice.

Patients who undergo laser treatment should have follow up every three months.

Diabetic patients who become pregnant are also at risk of developing diabetic retinopathy. Seek an ophthalmologist’s opinion in the first trimester.

Diabetic retinopathy patients with hypertension or renal disease should have regular ophthalmic check up every six months.

Preventive measures

Strict control of blood sugar is the mainstay. Your HbA1C levels should be around six per cent.

A healthy lifestyle including diet control and regular exercise helps avoid further complications.

Intensive control of blood pressure, renal function and serum lipid levels.

Blood haemoglobin should be within normal limits.

Avoid smoking.

E-mail: rajaneye@vsnl.com

Reese Witherspon had Lasik surgery

Research suggests that with the growing trend of Lasik surgery, almost 20 per cent of the people suffering from vision impairments will undergo Lasik surgery by 2015. With this kind of eye corrective surgery, people will not be dependant on eyeglasses or contact lenses which are tough to carry in day to day lives. For celebrities wearing glasses can make them pay heavily in terms of their acting career and popularity because celebrities need to look beautiful. Reese Witherspoon, the renowned American actress, is among various other celebrities who have trusted the procedure of Lasik surgery.
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Reese Witherspoon, 34, of ‘Legally Blonde’ fame, has been named one of the ‘100 Most Beautiful’ people four times. What many don’t know, is that the beautiful blonde actress has worn glasses most of her life. According to lasikeyesurgery.com, Reese underwent Lasik surgery to correct her vision.

Reese is most famous for her roles in movies like ‘Sweet Home Alabama’ and ‘Cruel Intentions’. She met ex-husband Ryan Phillipe on the set of the latter.

The year 2005 brought Reese lots of praise and recognition after her role in ‘Walk the Line’. She was awarded with an Oscar at that year’s Academy Awards. The success didn’t stop there, with Reese going on to win other prestigious awards like the Golden Globe, the Screen Actors Guild Award and BAFTA for the same role.

Reese was married to Ryan for eight years between 1999 and 2007, and the pair have two children: Ava and Deacon. Eleven-year-old Ava, who resembles her mother, has been spotted wearing glasses too. Will she be the next member in the family to undergo Lasik surgery?

Other celebrities who have had Lasik include Nicole KidmanBrad PittElton John, Cindy Crawford and  Jessica Simpson.

Kathy Griffin openly spoke about her nightmare of an experience with Lasik.

Images: PR Photos, Wikimedia Commons

Depression makes the world appear grey

If you think that everything around you appears grey when you are sad, this might be a sign of depression, says a recent health report published by www.sciencedaily.com. The researchers at the Freiburg University, Germany conducted a new research to find out the response of the retina to the different black and white contrasts.

The researchers conducted an ECG of the eyes of people who were suffering from depression and also on healthy individuals.

The results of the test showed that retinal contrast gain in the depressed patients was much lower. Also, an inverse relation between the severity of depression and the response of the retina was also seen.

According to www.independent.co.uk, the researchers now believe that depression works to change the person’s experience of the world around him.

People who suffer from depression are not able to judge the contrasts in the visual world. This is one of the factors that make the world a dull and less pleasurable place for them. The lead author of the health research was Dr. Ludger Tebartz van Elst and he believes that the further research needs to be done in this area.

He also said that “this method could turn out to be a valuable tool to objectively measure the subjective state of depression, having far-reaching implications for research as well as clinical diagnosis of and therapy for depression.”

Celebrities who have battled depression include Jim CarreyJ.K. RowlingHalle BerryHugh Laurie and Owen Wilson.

Images: http://www.sxc.hu/photo/1204620, http://www.sxc.hu/photo/1136463

Lasik allows Brad Pitt to see clearly

Hollywood pressures its celebrities to maintain a great image: perfect hair, perfect body, perfect smile, and perfect style. One of the hottest men Hollywood has to offer, Brad Pitt underwent Lasik surgery to keep up his sexy look.
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Apparently he thought he wasn’t as hot with glasses, or contact lenses were too difficult for him. In any case, lasikeyesurgery.com lists him as one of many celebrities who have had the procedure done.

Brad is certainly one of the hottest actors on the planet, and we don’t mean only looks-wise. He kick-started his career with minor roles in television in 1987, including a memorable role in ‘Dallas’. In 1992, Brad signed his first leading role in ‘A River Runs Through It’. His perfect abs in ‘Thelma and Louise’ then clinched his label as being one of the sexiest men alive, and his career began to soar.

Brad earned his first Golden Globe nomination starring opposite Anthony Hopkins in ‘Legends of the Fall’.

With two Academy Awards nominations, Brad Pitt has been part of many notable flicks including ‘Twelve Monkeys’, ‘Fight Club’, ‘Ocean’s Eleven’, ‘Mr. & Mrs. Smith’ and ‘The Curious Case of Benjamin Button’.

Being labeled as one of the most attractive men in the world has led to a media frenzy concerning his personal life. Famously engaged to Gwyneth Paltrow before being married to Jennifer Aniston for five years, Brad Pitt is currently in a relationship with Angeline Jolie. The couple has three adopted children as well as three biological children.

Other celebrities who have undergone Lasik include Nicole Kidman and Tiger Woods.

Brad Pitt quit smoking for his children.

Image: http://commons.wikimedia.org/wiki/File:Brad_Pitt_2007.jpg; Author: chris_natt